Date of Award

January 2013

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Judith Lichtman


Introduction: Coronary Heart Disease (CHD) is the leading cause of death worldwide. While different types of stress have been linked to CHD development and prognosis, literature regarding the effect of marital stress on positive health behaviors in the early recovery period following myocardial infarction (MI) is limited.

Objective: The present analysis was undertaken to explore the relationship between marital stress and medication adherence and physician follow up, two important components of early post-MI recovery.

Methods: VIRGO study participants who reported either being married or in a committed relationship at the time of study enrollment or at a 30-day follow-up interview were eligible for assessment of marital stress via the Stockholm Marital Stress Scale. Marital stress was evaluated for its role in patients' medication adherence and physician follow-up 30 days after experiencing an index MI. Bivariate analyses were conducted to examine the relationships between medication adherence, physician follow up, and demographic and medical history variables with marital stress level. Categorical and continuous variables were compared using the chi-square test and analysis of variance, respectively. Multivariate logistic regression models were constructed to examine whether increased marital stress was associated with decreased medication adherence and/or a reduced likelihood of following up with a physician within 30 days post-MI. In secondary analyses, models were stratified by sex to examine whether the relationships between marital stress and these early health behaviors differed among men and women.

Results: Among 1503 individuals enrolled in VIRGO who reported a significant relationship and completed the 30-day follow-up interview, severe marital stress was not significantly associated with medication adherence (OR: 0.94 [95%CI: 0.60-1.48]), follow-up with any physician (OR: 0.84 [95%CI: 0.63-1.12]), or cardiologist-specific follow-up (OR: 0.83 [95%CI: 0.66-1.06]) in multivariate-adjusted models. While severe marital stress was significantly more likely to be reported by women than men (p <0.001), in secondary analyses, sex differences were not observed for the relationships between marital stress and rates of medication adherence, any physician follow-up, or cardiologist follow-up.

Conclusions: Marital stress was not significantly associated medication adherence or physician follow up visits during the early post-MI recovery period, although trends towards lower rates of adherence and physician follow-up were observed in individuals reporting severe marital stress.


This is an Open Access Thesis.

Open Access

This Article is Open Access